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Court Determines that AIG Acted Improperly in Considering Long Term Disability Claim

Wednesday, September 11th, 2013

A Federal Judge has found that AIG failed to engage in a proper review process, and failed to make adequate findings as to the impact of the claimant’s impairments, and thus, determined that its decision was not supported by substantial evidence.

In this case, which came before the Court following an earlier remand of a prior case, the Judge considered the evidence and found that AIG had again failed to engage in an appropriate process, taking account of AIG’s failure to obtain a psychological examination of the claimant, or an examination that addressed the combination of the claimant’s physical and psychological impairments. Nor did they obtain a Functional Capacity Evaluation – eschewing any examinations in favor of having doctors review records only. And these paper only medical reviews were flawed, as they did not consider the totality of the medical records. The Court also was troubled by the medical review of the claimant’s physical impairments by AIG’s hired psychologist, questioning the qualifications to render such an opinion.

The Court was not convinced either that the hired psychologist properly considered the evidence in reaching the determination that the claimant was impaired from psychological issues, particularly where the hired doctor completely discounted opinions offered from treating doctors. AIG’s vocational assessment was also criticized by the Court, which noted that the report was deficient and did not consider the totality of the medical evidence. The vocational report was also inconsistent with prior determinations reached by AIG concerning the claimant, and such conflicting conclusion was made without explanation or justification.

Unfortunately, despite the multitude of defects in the claim process, the Court again remanded the claim back to AIG for further consideration, although legal fees were found to be appropriately assessed against AIG.

Adair v. AIG

Justin C Frankel

Written By:

Justin C. Frankel - Disability Insurance Attorney

Justin Frankel is a founding partner of the disability insurance law firm Frankel & Newfield and is a highly skilled litigator and advocate. He has published numerous articles on the challenges facing clients with private or individual disability insurance policies and those who own group or ERISA disability insurance policies.

Learn more about Justin | See Justin’s Publications



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